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Pregnancy and Alcohol

Reporting Requirements

Laws addressing requirements to report indicators or evidence, such as results from screening or toxicological testing of women or babies, of alcohol use or abuse by women during pregnancy.

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About This Policy: Pregnancy and Alcohol: Reporting Requirements

Period Covered: 1/1/1968 through 1/1/2023

This policy topic covers laws addressing requirements to report indicators or evidence, such as results from screening or toxicological testing of women or babies, of alcohol use or abuse by women during pregnancy.

Scientific research has established that alcohol consumption during pregnancy is associated with adverse health consequences. Fetal Alcohol Spectrum Disorders (FASD) is the term used to describe the range of birth defects caused by maternal alcohol consumption during pregnancy. FASD are considered the most common nonhereditary cause of mental retardation. Included in Fetal Alcohol Spectrum Disorders is the diagnosis often referred to as Fetal Alcohol Syndrome (FAS), which is the most severe form of FASD. It is characterized by facial defects, growth deficiencies, and central nervous system dysfunction. Also included in FASD are other types of alcohol-induced mental impairments that are just as serious, if not more so, than in children with FAS. The term "alcohol-related neurodevelopmental disorder" (ARND) has been developed to describe such impairments. Prenatally exposed children can also have other alcohol-related physical abnormalities of the skeleton and certain organ systems; these are known as alcohol-related birth defects (ARBD). (National Institute on Alcohol Abuse and Alcoholism, June 2000; Warren and Foudin, 2001; SAMHSA, 2004).

State and Federal governments have established various policies in response to the risks associated with drinking during pregnancy. This section of APIS addresses State and Federal laws concerning requirements to report suspicion or evidence of alcohol use or abuse by women during pregnancy. Evidence may consist of results from screening and/or toxicological testing of pregnant women or toxicological testing of babies after birth. Jurisdictions with reporting requirements differ with respect to whether reporting is mandatory or discretionary. Jurisdictions also vary based on who must report and the purpose of reporting. With respect to the latter, some jurisdictions require reporting for data-gathering purposes. Others use the information to refer women for assessment and treatment of alcohol problems or to refer cases to child welfare agencies for determination of the best interests of children born to women who used or abused alcohol during pregnancy.

One jurisdiction takes a different approach to reporting the results of medical tests during pregnancy. As of July 1, 2016, Indiana mandates that, unless ordered by a court, no physician, physician assistant, certified direct entry midwife, or advanced practice nurse may release the results of a pregnant woman’s medical tests to a law enforcement agency. This statute includes the results of urine tests, blood tests, or verbal screening or questioning about drug or alcohol abuse.

Explanatory Notes and Limitations Specifically Applicable to Pregnancy and Alcohol: Reporting Requirements

  1. APIS collects legal provisions that either specifically refer to FASD or issues related to prenatal alcohol exposure or refer to a condition that reasonably may be interpreted as referring to FASD or prenatal alcohol exposure (e.g., "prenatal substance abuse," "prenatal legal drug abuse") or to a condition that reasonably may be interpreted as referring to alcohol abuse (e.g., "substance abuse," "use of legal drugs," "addictive drug," "drug of abuse").
  2. APIS does not collect provisions that refer only to "controlled substances" or those that exclude alcohol.
  3. If a State law provides for a report or notification that could lead to an investigation by the State’s child protection or child welfare agency resulting in a child welfare proceeding, the law is collected for purposes of the Referral to Child Welfare Agency variable.
  4. If a State law provides for a report or notification to a State department for purposes of assessment or treatment of the child, the child's parents, or immediate caregivers (e.g. as part of a Plan of Safe Care), the law is collected for purposes of the Referral for Assessment and/or Treatment variable, as long as the law can reasonably be interpreted as applying to the mother’s conduct during pregnancy (for this purpose, references to FASD or terms such as “infant”, “newborn,” or “child born affected by” are sufficient). If the law only relates to treatment for the mother/parent/caregiver, or the child, and the context does not apply to the mother’s conduct during pregnancy, the law is not collected.
  5. APIS does not include laws requiring or allowing child welfare agencies to report a child's diagnosis of fetal alcohol syndrome to foster care or other out-of-home care providers.
  6. APIS does not code legal provisions that impose no affirmative duty to report a woman who uses alcohol during pregnancy or a child with fetal alcohol syndrome but nevertheless impose a duty on relevant governmental agencies or personnel to conduct an investigation into a woman's alcohol use or abuse if a report is received. These provisions are noted in the Row Notes or Jurisdiction Notes for jurisdictions that have such provisions.
  7. With respect to the Data Gathering variables (presented for both Mandatory and Discretionary provisions), a check mark is used for States that require or allow collection of statistical data on alcohol use or misuse during pregnancy for inclusion in aggregate statistical datasets. A checkmark is not given for provisions that allow or require data collection for other purposes (e.g., reports of individual data for the purpose of referring individual women to social services or to criminal or civil legal proceedings), or where the context does not specifically apply to the mother’s conduct pertaining to alcohol during pregnancy.

Explanatory Notes and Limitations Applicable to All APIS Policy Topics

  1. State law may permit local jurisdictions to impose requirements in addition to those mandated by State law. Alternatively, State law may prohibit local legislation on this topic, thereby preempting local powers. For more information on the preemption doctrine, see the About Alcohol Policy page. APIS does not document policies established by local governments.
  2. In addition to statutes and regulations, judicial decisions (case law) also may affect alcohol-related policies. APIS does not review case law except to determine whether judicial decisions have invalidated statutes or regulations that would otherwise affect the data presented in the comparison tables.
  3. APIS reviews published administrative regulations. However, administrative decisions or directives that are not included in a State's published regulatory codes may have an impact on implementation. This possibility has not been addressed by the APIS research.
  4. Statutes and regulations cited in tables on this policy topic may have been amended or repealed after the specific date or time period specified by the site user's search criteria.
  5. The operation or enforcement of statutes or regulations affecting the policies addressed on APIS may have been suspended or modified by executive or administrative orders issued in response to the COVID-19 pandemic. With the exception of the COVID-19 Digest and Dataset, APIS research does not address these orders or the effects they may have on the policies covered by APIS.
  6. Policy changes in APIS are presented as of the date these changes take effect as law. Users should be aware that in some situations there may be a delay between the effective date of a law and the time a corresponding policy change occurs in practice. Because APIS research is based entirely on primary legal source materials (codified statutes and regulations and, on rare occasions, published court opinions), APIS is unable to accurately determine when policy changes may appear in practice.
  7. If a conflict exists between a statute and a regulation addressing the same legal issue, APIS coding relies on the statute.
  8. A comprehensive understanding of the data presented in the comparison tables for this policy topic requires examination of the applicable Row Notes and Jurisdiction Notes, which can be accessed from the body of the table via links in the Jurisdiction column.

(Policies in effect on: 1/1/2023)

Two Federal statutes (25 U.S.C. § 1680d and 42 U.S.C. § 706) related to data and information gathering on fetal alcohol syndrome have been identified by APIS.  Each of the statutes requires reports about rates of fetal alcohol syndrome and/or plans for reduction of incidents of FAS by the fifty States and the District of Columbia.  The reports must be submitted either to Congress or the President of the United States.

In addition, on December 20, 2010, the President signed a third law (amending 42 U.S.C. § 5106a), which reauthorized and amended the Child Abuse Prevention and Treatment Act (CAPTA), codified at 42 U.S.C. ch. 67, subchapters I, III, V. This law, as amended by the Comprehensive Addiction and Recovery Act of 2016 (CARA) (PL 114-198, July 22, 2016, 130 Stat 695), provides Federal grant money to improve State child protection services. Under the law, States that seek CAPTA funding are required to submit a plan that contains requirements relating to health care workers’ duty to report to child welfare agencies infants born with Fetal Alcohol Spectrum Disorders for purposes of referral for assessment and/or treatment.

Relevant portions of these statutes appear below.

FEDERAL CITATIONS AND RELEVANT TEXT EXCERPTS

25 U.S.C. § 1680d
United States Code
Title 25 - INDIANS
CHAPTER 18 - INDIAN HEALTH CARE
SUBCHAPTER VI - MISCELLANEOUS
§ 1680d. Infant and maternal mortality; fetal alcohol syndrome

  • By no later than January 1, 1990, the Secretary shall develop and begin implementation of a plan to achieve the following objectives by January 1, 1994:
  • * * *
    • (3) reduction of the rate of fetal alcohol syndrome among Indians served by, or on behalf of, the Service to one per one thousand live births.

42 U.S.C. § 706
United States Code
Title 42 - THE PUBLIC HEALTH AND WELFARE
CHAPTER 7 - SOCIAL SECURITY
SUBCHAPTER V - MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT
§ 706. Administrative and fiscal accountability

  • (a) Annual reporting requirements; form, etc.

    • (1) Each State shall prepare and submit to the Secretary annual reports on its activities under this subchapter. Each such report shall be prepared by, or in consultation with, the State maternal and child health agency. In order properly to evaluate and to compare the performance of different States assisted under this subchapter and to assure the proper expenditure of funds under this subchapter, such reports shall be in such standardized form and contain such information * * * as the Secretary determines (after consultation with the States) to be necessary * * * . Copies of the report shall be provided, upon request, to any interested public agency, and each such agency may provide its views on these reports to the Congress.
    • (2) Each annual report under paragraph (1) shall include the following information:
    • * * *
      • (B) Information on the status of maternal and child health in the State, including—
      • * * *
        • (ii) information (on a State-wide basis) on—
        • * * *
          • (V) the proportion of infants born with fetal alcohol syndrome,
  • * * *
    • (3) The Secretary shall annually transmit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report that includes—
    • * * *
      • (C) based on information described in paragraph (2)(B) supplied by the States under paragraph (1), a compilation of the following measures of maternal and child health in the United States and in each State:
      • * * *
        • (ii) Information on—
        • * * *
          • (IV) the proportion of infants born with fetal alcohol syndrome,

* * *

42 U.S.C. § 5106a
United States Code
Title 42 - THE PUBLIC HEALTH AND WELFARE
CHAPTER 67 - CHILD ABUSE PREVENTION AND TREATMENT AND ADOPTION REFORM
SUBCHAPTER I - GENERAL PROGRAM
§ 5106a. Grants to States for child abuse or neglect prevention and treatment programs

* * *

  • (b) Eligibility requirements
  • * * *
  • (2) Contents
  • A State plan * * * shall contain a description of the activities that the State will carry out using amounts received under the grant to achieve the objectives of this subchapter, including--
  • * * *
  • (B) an assurance in the form of a certification by the Governor of the State that the State has in effect and is enforcing a State law, or has in effect and is operating a statewide program, relating to child abuse and neglect that includes--
  • * * *
  • (ii) policies and procedures (including appropriate referrals to child protection service systems and for other appropriate services) to address the needs of infants born with and identified as being affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure, or a Fetal Alcohol Spectrum Disorder, including a requirement that health care providers involved in the delivery or care of such infants notify the child protective services system of the occurrence of such condition in such infants, except that such notification shall not be construed to--
  • (I) establish a definition under Federal law of what constitutes child abuse or neglect; or
  • (II) require prosecution for any illegal action;
  • (iii) the development of a plan of safe care for the infant born and identified as being affected by substance abuse or withdrawal symptoms, or a Fetal Alcohol Spectrum Disorder to ensure the safety and well-being of such infant following release from the care of health care providers, including through-- (I) addressing the health and substance use disorder treatment needs of the infant and affected family or caregiver; and (II) the development and implementation by the State of monitoring systems regarding the implementation of such plans to determine whether and in what manner local entities are providing, in accordance with State requirements, referrals to and delivery of appropriate services for the infant and affected family or caregiver;
  • (iv) procedures for the immediate screening, risk and safety assessment, and prompt investigation of such reports; * * *

* * *

Source for all citations on this page: www.govinfo.gov/, a service of the U.S. Government Publishing Office (GPO). Excerpts from the United States Code are current as of 2022. Excerpts from the Code of Federal Regulations are current as of 2023. Excerpts from Public Laws of Congress are current as of the year of enactment. The GPO’s Public Domain & Copyright Notice is available at https://www.govinfo.gov/about/policies#copyright .

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